Ernest H. Johnson

White coat versus "sustained" borderline hypertension in Tecumseh, Michigan.

During a survey of young subjects not receiving treatment for hypertension in Tecumseh, Michigan, clinic and self-monitored blood pressures taken at home (14 readings in 7 days) were obtained in 737 subjects (387 men, 350 women, average age 31.5 years). Hypertension in the clinic was diagnosed if the clinic blood pressure exceeded 140 mm Hg systolic or 90 mm Hg diastolic. In the absence of firm criteria for what constitutes hypertension at home, subjects whose average home blood pressure was in the upper decile of the whole population were considered to have hypertension at home. By these criteria, 7.1% of the whole population had “white coat” hypertension (i.e., high clinic but not elevated home readings). The prevalence of “sustained” hypertension (i.e., high readings in the clinic and at home) was 5.1%. Subjects with white coat and sustained borderline hypertension in Tecumseh were very similar. Both groups showed, at previous examinations (at ages 5, 8, 21, and 23 years), significantly higher blood pressure readings than the normotensive subjects. As young adults (average age 333 years), the parents of both hypertensive groups had significantly higher blood pressure readings than the parents of normotensive subjects. Both hypertensive groups had faster heart rates, higher systemic vascular resistance, and higher minimal forearm vascular resistance. Both hypertensive groups were more overweight, had higher plasma triglycerides, insulin, and insulin/glucose ratios than normotensive subjects. The white coat hypertensive group also had lower values of high density lipoprotein than the normotensive group. White coat hypertension is a frequent condition. In regards to excessive risk of hypertension (past blood pressures, parental blood pressures, weight, and heart rate), excessive risk for atherosclerosis (triglycerides and insulin), and hemodynamic parameters (vascular resistance and minimal forearm resistance), the white coat and sustained hypertensive groups are similarly different from the normotensive group. These findings do not support the accepted practice of using home blood pressure determination to distinguish groups of borderline hypertensive subjects with a lesser or greater clinical problem.

Hyperkinetic borderline hypertension in Tecumseh, Michigan

Of 691 healthy (untreated) villagers of Tecumseh, Michigan (average age 32.6 years), 99 had a clinical blood pressure exceeding 140/90 mmHg. Thirty-seven per cent of these borderline hypertensives had increased heart rate, cardiac index, forearm blood flow and plasma norepinephrine. These subjects had elevated self-determined home blood pressure (average of 14 measurements). The present hyperkinetic borderlines had elevated blood pressure at 5, 8, 21 and 23 years of age and their parents also had higher blood pressure. The prevalence of high blood pressure in Tecumseh, its long history, elevated blood pressure readings outside the physicians office and family background of hypertension, suggests that the hyperkinetic state is a significant clinical condition. Previous studies on hospital-based populations proved that the hyperkinetic state is caused by an excessive autonomic drive. The association of the hyperkinetic state with elevated norepinephrine in this study suggests that a sympathetic hyperactivity is present in a large proportion of unselected subjects with mild blood pressure elevation.

The relationship of anger expression to health problems among black americans in a national survey

This study examined the relationship between anger expression, other psychosocial measures, and health problems in a nationally representative, cross-sectional sample of 1277 black adults. Subjects indicating a high level of outwardly expressed anger during a period in which they experienced a severe personal problem had a significantly higher number of health problems than their counterparts who expressed low and moderate levels of anger. Anger expression also significantly interacted with a measure of life strain (employment status) to predict health problems. Blacks who were unemployed were more likely to have a higher number of health problems if anger was expressed outwardly at a high level. The relationship was found to be independent of age, gender, urbanicity, smoking, and drinking problems. The overall pattern of the findings suggests that blacks who are at increased risk for health problems may be identified by how often anger is experienced and expressed during periods of emotional distress.